<head>
<meta name="viewport" content="width=device-width, initial-scale=1">
<link rel="stylesheet" href="http://apps.bdimg.com/libs/jquerymobile/1.4.5/jquery.mobile-1.4.5.min.css">
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<style type="text/css">

.ui-field-contain .ui-controlgroup-controls{
   width: 38%;
}
</style>
</head>

<body >
<div data-role="page"  style="background-color: #f0fbff;">

  <div data-role="header" >
    <h1>信息详情录入</h1>
  </div>

  <div data-role="main" class="ui-content">
    <table>
    <tr>
    <td> <label for="provider_name">姓名:</label></td>
    <td><input type="text" name="provider_name"  id="provider_name" data-clear-btn="true" placeholder="请输入姓名1"> </td>
    </tr>
    </table>
    
    <label for="provider_phone_number">手机号码:</label>
    <input type="text" name="provider_phone_number" id="provider_phone_number" data-clear-btn="true" placeholder="请输入手机号码">
    
    <!-- <fieldset class="ui-field-contain"> -->
	<label for="provid">潜在项目所在区域:</label>
	<select name="provid" id="provid">
		<option value="10001">北京</option>
		<option value="10002">上海</option>
	</select>
	<!-- </fieldset> -->
	<select name="cityid" id="cityid">
		<option value="10001">北京</option>
		<option value="10002">上海</option>
	</select>
	
	<label for="project_start_time">潜在项目启动时间:</label>
	<select name="project_start_time" id="project_start_time">
					<option value="2019年第3季度">2019年第3季度</option>
					<option value="2019年第4季度">2019年第4季度</option>
					<option value="2020年第1季度">2020年第1季度</option>
					<option value="2020年第2季度">2020年第2季度</option>
					<option value="2020年第3季度">2020年第3季度</option>
					<option value="2020年第4季度">2020年第4季度</option>
	</select>
	
	<legend>潜在项目预估规模:</legend>
	<label for="scale1">100万及以下</label>
	<input type="radio" name="scale" id="scale1"  value="100万及以下" checked> 
	<label for="scale2">500万及以下</label>
	<input type="radio" name="scale" id="scale2"  value="500万及以下"> 
	<label for="scale3">1000万及以下</label>
	<input type="radio" name="scale" id="scale3"  value="1000万及以下"> 
	<label for="scale4">3000万及以下</label>
	<input type="radio" name="scale" id="scale4"  value="3000万及以下">
	<label for="scale5">5000万及以下</label>
	<input type="radio" name="scale" id="scale5"  value="5000万及以下">
	<label for="scale6">1亿及以下</label>
	<input type="radio" name="scale" id ="scale6"  value="1亿及以下">
	<label for="scale7">大于一亿</label>
	<input type="radio" name="scale" id="scale7"  value="大于一亿">
	<label for="scale8">其他</label>
	<input type="radio" name="scale" id="scale8"  value="其他">

	<legend>潜在客户类型:</legend>
	<label for="customer_type1">制造业/产业集群</label>
	<input type="radio" name="customer_type" id="customer_type1" value="制造业/产业集群" checked> 
	<label for="customer_type2">石油化工/工矿企业</label>
	<input type="radio" name="customer_type" id="customer_type2" value="石油化工/工矿企业" > 
	<label for="customer_type3">商务区/连锁企业</label>
	<input type="radio" name="customer_type" id="customer_type3" value="商务区/连锁企业" > 
	<label for="customer_type4">交通枢纽(火车站/机场/高速公路)</label>
	<input type="radio" name="customer_type" id="customer_type4" value="交通枢纽(火车站/机场/高速公路)" >
	<label for="customer_type5">市政基础设施(医院/学校等)</label>
	<input type="radio" name="customer_type" id="customer_type5" value="市政基础设施(医院/学校等)" >
	<label for="customer_type6">清洁能源</label>
	<input type="radio" name="customer_type" id="customer_type6" value="清洁能源" >
	<label for="customer_type7">其他</label>
	<input type="radio" name="customer_type" id="customer_type7" value="其他" >			
	 
	<label for="project_description">潜在项目描述:</label>
	<textarea   id="project_description" name="project_description" placeholder="请输入内容"></textarea>
		
	<label for="headImg">上传照片:</label>	
	<input type="file"  accept="image/*" id="headImg" name="headImg" />
	
	<legend>我关心项目进展:</legend>
	<label for="project_progress1">每月反馈跟踪情况</label>
	<input type="radio" name="project_progress" id="project_progress1" value="每月反馈跟踪情况" >
	<label for="project_progress2">每季反馈跟踪情况</label>
	<input type="radio" name="project_progress" id="project_progress2" value="每季反馈跟踪情况" >
	<label for="project_progress3">每半年反馈跟踪情况</label>
	<input type="radio" name="project_progress" id="project_progress3" value="每半年反馈跟踪情况" > 
	<label for="project_progress4">其他反馈方式</label>
	<input type="radio" name="project_progress" id="project_progress4" value="其他反馈方式" >
	
	<legend>我需要一次面对面沟通:</legend>
	<label for="communic1">尽快与我取得联系</label>
	<input type="radio" name="communic" id="communic1" value="尽快与我取得联系"> 
	<label for="communic2">我来指定时间和地点</label>
	<input type="radio" name="communic" id="communic2" value="我来指定时间和地点">	
	
	<input type="button" name="button" value="立即提交">
  </div>

  <div data-role="footer">
    <h1>正泰电力服务</h1>
  </div>

</div>
</body>


